<link rel="stylesheet" media="screen" type="text/css" href="<?php echo bu("css/datepicker.css"); ?>" />
<script type="text/javascript" src="<?php echo bu("js/datepicker.js"); ?>"></script>
<script>
		$(function() {
      $( ".dpicker" ).datepicker({
        changeMonth: true,
        changeYear: true,
        dateFormat: 'd MM yy',
      });
    });
</script>

<div class='mainContainer home'> <!-- Main div for the contain, behaves like a table-->
	<div><!-- Direct child of mainContainer, behaves like a table cell-->
		<?php // echo $this->renderPartial('/partials/_notifications'); ?>
		<h2 class='differentAlign'>EFL Registration Form</h2>
		<div class='spacer'>&nbsp;</div>
		<?php
      $form=$this->beginWidget('CActiveForm', array(
      'action' => bu('users/efl'),
      // 'enableClientValidation'=>true,
      'htmlOptions' => array(
        'name' => 'myForm',
        'id' => 'myForm',
      )
      ));
    ?>
      <?php echo $form->errorSummary($model); ?><br />

      <fieldset>
        <legend>Personal Data</legend>
          <div class="field">
            <?php echo $form->labelEx($model,'name'); ?>
            <?php echo $form->textField($model, 'name', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'name'); ?>
          </div>
          <div class="field radio-horizontal">
            <?php echo $form->labelEx($model,'sex'); ?>
            <?php
              $arr = array(
                'Male' => 'Male',
                'Female' => 'Female',
              );
            ?>
            <?php echo $form->radioButtonList($model, 'sex', $arr, array('separator' => '', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'sex'); ?>
          </div>
          <div class="field">
            <?php echo $form->labelEx($model,'email'); ?>
            <?php echo $form->textField($model, 'email', array('class' => 'full')); ?>
            <?php echo $form->error($model, 'email'); ?>
          </div>
          <div class="field">
            <?php echo $form->labelEx($model,'contact_number'); ?>
            <?php echo $form->textField($model, 'contact_number', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'contact_number'); ?>
          </div>
          <div class="field">
            <?php echo $form->labelEx($model,'country_of_origin'); ?>
            <?php echo $form->textField($model, 'country_of_origin', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'country_of_origin'); ?>
          </div>
          <div class="field">
            <?php echo $form->labelEx($model,'institution_school'); ?>
            <?php echo $form->textField($model, 'institution_school', array('class' => 'full')); ?>
            <?php echo $form->error($model, 'institution_school'); ?>
          </div>
          <div class="field">
            <?php echo $form->labelEx($model,'current_position'); ?>
            <?php echo $form->textField($model, 'current_position', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'current_position'); ?>
          </div>
      </fieldset>
      
      <fieldset>
        <legend>Seminar Data</legend>
          <div class="field radio-vertical">
            <?php echo $form->labelEx($model,'options'); ?>
            <?php
              $arr = array(
                'EFL Workshop only' => 'EFL Workshop only',
                'EFL Workshop & Full Stay during SELC' => 'EFL Workshop & Full Stay during SELC',
              );
            ?>
            <?php echo $form->radioButtonList($model, 'options', $arr, array('separator' => '', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'options'); ?>
          </div>
          <div class="field">
            <?php echo $form->labelEx($model,'date_of_payment'); ?>
            <?php echo $form->textField($model, 'date_of_payment', array('class' => 'dpicker full', 'readonly' => true)); ?>
            <?php echo $form->error($model, 'date_of_payment'); ?>
          </div>
          <div class="field radio-horizontal">
            <?php echo $form->labelEx($model,'payment_in'); ?>
            <?php
              $arr = array(
                'USD' => 'USD',
                'Rupiah' => 'Rupiah',
              );
            ?>
            <?php echo $form->radioButtonList($model, 'payment_in', $arr, array('separator' => '', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'payment_in'); ?>
          </div>
          <div class="field">
            <?php echo $form->labelEx($model,'date_of_arrival'); ?>
            <?php echo $form->textField($model, 'date_of_arrival', array('class' => 'dpicker full', 'readonly' => true)); ?>
            <?php echo $form->error($model, 'date_of_arrival'); ?>
          </div>
          <div class="field">
            <?php echo $form->labelEx($model,'date_of_departure'); ?>
            <?php echo $form->textField($model, 'date_of_departure', array('class' => 'dpicker full', 'readonly' => true)); ?>
            <?php echo $form->error($model, 'date_of_departure'); ?>
          </div>
      </fieldset>
      
      <fieldset>
        <legend>Please confirm captcha correctly</legend>
        <?php $form->widget('CCaptcha'); ?><br />
        <?php echo $form->textField($model, 'verifyCode'); ?>
        <?php echo $form->error($model, "verifyCode"); ?>
      </fieldset>

      <p>* is required</p>
			<input type='submit' value='Submit' />
			<input type='submit' value='Reset' />
		<?php $this->endWidget(); ?>
	</div>

    <div class='rightPane'>
		<h2 class='differentAlign'>Our <span class='differentHeading'>Contact</span></h2>
		<div class="contact">
			<h3>ACSI Head Quarters</h3>
      731 Chapel Hills Drive Colorado Springs<br />
      CO 80920.3949<br />
      Phone : +1.719.528.6906<br />
      Fax : +1.719.531.0631<br />
      Email : info@acsiglobal.org
		</div>
    <div class="contact">
			<h3>ACSI Indonesia</h3>
      Komplek Ruko Klampis Megah B-25<br />
      Jl. Klampis Madya Utara I/6<br />
      Surabaya - Jawa Timur 60117<br />
      Phone/Fax : +62.31-591.0897, 591.3068<br />
      Phone : +62.31-592.9902<br />
      Mobile : +62.31-8193.5548<br />
      Email : acsi-indonesia@acsi.or.id<br />
      http://acsiglobal.org; acsi.or.id
		</div>
    <div class="contact">
			<h3>Indonesia Representative Office</h3>
      <b>Jakarta</b><br />
      Jl. Kwitang Raya No. 4, 3rd Floor<br />
      Senen - Jakarta Pusat 10420<br />
      Phone/Fax : +62.21-391.1207<br />
      Mobile : +62.31-3631-8020<br />
      Email : acsi-jakarta@acsi.or.id
		</div>
	</div>
</div>

<div class='spacer'>&nbsp;</div>